HomeMy WebLinkAboutHIVE CONSTRUCTION INC - INSURANCE CERTIFICATE (3)® DATE (MMIDD/YYYY) AC�
AC� CERTIFICATE OF LIABILITY INSURANCE 1/30/2017
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to
the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the
certificate holder in lieu of such endorsements).
PRODUCER CONTACT Brandie Zuckerman CRIS
NAME:
Moody Insurance Agency, Inc. PPHONE (303)824-6600 No: (303)370-0118
8055 East Tufts Avenue E-MAIL ADDRESS: brandie.zuckerman@moody ins.com
Suite 1000 INSURE S AFFORDING COVERAGE NAIC0
Denver CO 80237 INSURERA:Travelers Indemnity Company 25658
INSURED INSURER B :Travelers Indentnity of America 25666
HIVE Construction, Inc. INSURERC:
4701 Marion St INSURERD:
Ste 201 INSURER E :
Denver CO 80216 INSURER F :
COVERAGES CERTIFICATE NUMBER:17-18 Master REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR ADDLTYPE OF INSURANCE J= SUER POLICY NUMBER MMLIDY MMIDDPOLICY EXP LIMITS
LTR WVD
X
COMMERCIAL GENERAL LIABILITY
EACH OCCURRENCE
$ 1,000,000
A
CLAIMS -MADE X OCCUR
ENTED
PREMISES Ea occurrence
$ 300,000
MED EXP Any one person)
$ Excluded
DTC06G98061617COF
2/1/2017
2/1/2018
PERSONAL & ADV INJURY
$ 1,000,000
GEN'L
AGGREGATE LIMIT APPLIES PER:
GENERAL AGGREGATE
$ 2,000,000
POLICY Fx_1 JPERO LOC
PRODUCTS - COMP/OP AGG
$ 2,000,000
$
OTHER:
AUTOMOBILE LIABILITY
COMBINED SINGLE LIMIT
(Ea accident
$ 1,000,000
BODILY INJURY (Per person)
$
A
ANY AUTO
ALL OWNED SCHEDULED
AUTOS X AUTOS
BA6G98230817CNS
2/1/2017
2/1/2018
BODILY INJURY (Per accident)
$
PROPERTY DAMAGE
Per accident)$
NON -OWNED
X HIRED AUTOS AUTOS
X
UMBRELLALIA6
X
OCCUR
EACH OCCURRENCE
$ 5,000,000
AGGREGATE
$ 5 ,000,000
B
EXCESS LIAB
CLAIMS -MADE
DED I X I RETENTION$ 0
DTSMCUP6G980617TIL
2/1/2017
2/1/2016
$
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY Y / N
ANY PROPRIETOR/PARTNER/EXECUTIVE —]
PER OTH-
X STATUTE ER
E.L. EACH ACCIDENT
$ 1,000,000
A
MFandatoMEMBER m NH)EXCLUDED?
( ry
NIA
DTJUB7G97096A17 2/1/2017
2/1/2018
E.L. DISEASE - EA EMPLOYEE
$ 1,000,000
If yes, describe under
DESCRIPTION OF OPERATIONS below
E.L. DISEASE - POLICY LIMIT
$ 1,000,000
A
Leased/Rented
DTC06G96061617COF 2/1/2017
2/1/2018 (Limit 50,000
DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
rrPTIr:lrATF wni r1FR r'ANrFI I ATIr1N1
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
City
of Fort Collins
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
P.O.
BOX 580
ACCORDANCE WITH THE POLICY PROVISIONS.
Fort
Collins, CO 80526
AUTHORIZED REPRESENTATIVE
B Zuckerman, CRIS/BRAS
91988-2014 ACORD CORPORATION. All rights reserved.
ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD
INS025 (201401)